Research ArticleClinical Studies
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Intraoperative Bleeding Complications Leading to Blood Transfusions (BloTs) in 17,412 Cholecystectomies in Finland: A Study With Special Reference to Elderly Patients

ANTTI KIVIVUORI, PEKKA LAMMI, MATTI ESKELINEN, TUOMO RANTANEN, HANNU PAAJANEN, JUKKA PULKKINEN and MIKA UKKONEN
Anticancer Research October 2024, 44 (10) 4449-4456; DOI: https://doi.org/10.21873/anticanres.17274

Abstract

Background/Aim: Cholelithiasis (Chole) is one of the most common diseases needing operative management worldwide. However, there are few studies assessing the intraoperative bleeding (IOB) complications leading to blood transfusions (BloTs) in elderly patients with cholecystectomy (Ccy). Patients and Methods: Outcome after IOB complications and need for BloTs in a cohort of 17,412 patients with Ccys were assessed with special reference to elderly Ccy patients. Results: A total of 17,412 patients underwent Ccy and 11% of Ccy patients (1,856/17,412) were aged ≥75 years. The Ccy patients ≥75 years underwent more often emergency/open Ccys. Red blood cell BloTs were administered five times more often to Ccy patients ≥75 years versus Ccy patients <75 years (13% versus 2.6%, p<0.001). In Ccys by emergency surgery indications, the need for BloTs was four times higher in Ccy patients ≥75 years versus Ccy patients <75 years (5.5% versus 1.3%, p<0.001). Conclusion: The elderly Chole patients have a higher risk than younger Chole patients for perioperative IOB complications and thus are more likely to need BloTs.

Key Words:

Cholelithiasis (Chole) and cholecystitis are among the most common diseases needing operative management worldwide with 750,000 cholecystectomies (Ccys) performed annually in the United States (1) and almost 18 million Ccys worldwide every year (1-3). Chole represents one of the most common gastroenterological diseases in elderly patients (1-7) and quality of life (QoL) reports following Ccy often relate outcomes to post-surgery complications, duration of hospitalization, morbidity, and mortality. However, these reports frequently lack assessment of intraoperative bleeding (IOB) complications (8-13). Although, IOB could be a poor measure of QoL for elective surgery as Ccy, where perioperative harms are infrequent (12-14), elderly Ccy patients are often using antithrombotic drugs associated with increased risk for IOB following surgery (15). In addition, elderly Ccy patients often present with common bile duct (CBD) stones (16-22) and more severe inflammatory changes (23) leading to an increased risk of conversion from laparoscopic cholecystectomy (LC) to open cholecystectomy (OC), which may lead to IOB and a prolonged duration of hospitalization. Lammi et al. (24) assessed the perioperative blood transfusions (BloTs) in a cohort of 1,337 patients with pancreatic surgery (PaSurg). They found no differences between high-, medium- and low-volume hospitals in the use of BloTs and trigger points for BloTs after PaSurg. However, the authors suggested a better use of reserved blood units after PaSurg. More recently, the same authors (25) investigated BloTs in 732 partial hepatic resection (HePa) patients versus 864 PaSurg patients and divided the study patients into the BloT negative (BloT-) and BloT positive groups (BloT+). The authors found quite similar perioperative changes in Hb levels in BloT- versus BloT+ groups of HePa and PaSurg patients regardless of whether they received BloTs or not. However, there is a lack of studies assessing the role of IOB complications leading to BloTs in elderly patients with Ccy, which is one of the most common surgical procedures performed in elderly patients. Therefore, the purpose of this work was to investigate the IOBs and BloTs in a cohort of 17,412 Ccys in Finland.

Patients and Methods

Permission to use the Optimal Use of Blood (OUB) registry was obtained from the Review Board of the Finnish Red Cross Blood Service, Helsinki, Finland (26). The study was conducted in accordance with the Helsinki Declaration and the study protocol was approved by the Ethical Board of the Finnish Red Cross Blood Service, Helsinki, Finland (26).

The following data were collected: age, sex, American Society of Anesthesiologists physical status score (ASA), main diagnosis, surgical procedure, hemoglobin (Hb) level, platelet values, red blood cell (RBC) BloTs, plateletBloTs, fresh frozen plasma (FFP) BloTs, and International Normalized Ratio (INR) values. Detailed description of the study protocol is shown in reports by Palo et al. (26-30).

Statistical analysis. Baseline demographic characteristics are presented as absolute values with percentages or medians with interquartile ranges. Two-tailed Chi-square test or Fisher’s exact test were used to compare categorical variables, and the Student’s t-test, Mann-Whitney U-test or Kruskal-Wallis test were employed in the comparison of continuous study variables. Statistical significance was set at p-value<0.05. Data were analyzed by IBM SPSS statistical software (IBM SPSS Statistics for Windows, version 26.0, IBM Corporation, Armonk, NY, USA).

Results

Baseline data. A total of 17,412 patients undergoing Ccy for symptomatic Chole were included and baseline study characteristics are shown in Table I. Of the study patients, 89% (15,556/17,412) were younger than 75 years and 11% (1,856/17,412) were ≥75 years old. The elderly patients (≥75 years of age) had a higher ASA class, underwent more often emergency operations, had a higher risk for OC, and underwent more often CBD explorations (p<0.001). Furthermore, the preoperative Hb levels of the elderly Ccy patients were also lower when compared to younger Ccy patients.

View this table:
Table I.

Baseline data of open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) patients in two age groups.

Data of IOB complications and BloTs in two age groups (<75 years versus ≥75 years of age). The need for BloTs in study patients is presented in Table II. In total, 13% (242/1856) of the elderly Ccy patients (≥75 years) received RBC BloTs, while only 2.6% (398/15,556) of younger Ccy patients (<75 years) needed the BloTs (p<0.001). Massive BloTs (>10 blood units) were rare in both groups. However, the Ccy patients ≥75 years had a higher risk for massive BloTs in comparison to Ccy patients <75 years of age (0.6% versus 0.2%, p<0.001). Corresponding figures are shown, when comparing elderly Ccy patients versus younger Ccy patients in platelet BloTs (1.1% versus 0.3%, p<0.001) and FFP BloTs (5.3% versus 0.8%, p<0.001). The elderly Ccy patients with emergency Ccy had a higher risk for RBC BloTs in comparison to younger Ccy patients (21% versus 6.2%, p<0.001). The elderly Ccy patients also received BloTs more often than younger Ccy patients after elective surgery. The lowest perioperative Hb levels were relatively similar in both age groups, as shown in Figure 1. Only a small proportion of study patients had a Hb level below 80 g/l and the presence of severe anemia was uncommon. The BloTs were more often given to those with high ASA levels (Figure 2).

View this table:
Table II.

Red blood cell (RBC), fresh frozen plasma (FFP), and platelet transfusions in open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) patients divided into two age groups.

Figure 1.
Figure 1.

A violin plot showing hemoglobin levels in cholecystectomy (Ccy) patients divided into two age groups. A) Elective versus emergency Ccy patients <75 years old, B) Elective versus emergency Ccy patients ≥75, C) Laparoscopic cholecystectomy (LC) versus open cholecystectomy (OC) patients <75 years old and D) LC versus OC patients ≥75 years old.

Figure 2.
Figure 2.

Percentages of cholecystectomy patients receiving red blood cell transfusions according to their American Society of Anesthesiologists (ASA) physical status classification. A) Patients under 75 years. B) Patients aged 75 or more. Dots and numbers indicate the number of patients in each group.

Discussion

The IOBs and BloTs for surgical patients are not everyday procedures and it is evident that patients with IOBs and BloTs are more complicated than average surgical patients. Nevertheless, it should be noted that the liberal use of BloTs in surgical patients is not harm-free (31). Previously it has been shown that patients with IOB complications treated with strict criteria for BloTs had a lower risk for morbidity, when compared to patients treated with a liberal BloT-protocol (32). In addition, the IOB and BloTs have been reported to decrease overall survival (OS) after surgical resection of malignancies (33-42).

Papadoniou et al. (33) assessed 24 prognostic factors in 215 patients with locally advanced (unresectable) or metastatic pancreatic adenocarcinoma (PaCa) and showed that BloT was a significant predictive factor for poor survival in univariate analysis (Log-rank test value=96.2, p<0.001).

Fujiwara et al. (34) investigated Glasgow prognostic score (GPS) and BloTs in relation to post-operative complications in 66 patients with hepatocellular carcinoma (HCC) undergoing HePa. The authors performed multivariate analysis and IOB and GPS were independent risk factors for pulmonary complications; (p=0.0118 for IOB, p=0.0143 for GPS), RBC BloTs (p=0.0036 for IOB, p=0.0117 for GPS), and FFP BloTs (p=0.002 for IOB, p=0.0044 for GPS). They concluded that GPS predicted the preoperative status of HCC patients, and IOB complications were reflected in the use of BloTs and pulmonary complications in HePa of HCC patients.

Shiba et al. (35) studied a cohort of 65 colorectal cancer (CRC) patients with liver metastasis, who underwent HePa and found a negative impact of the BloTs on OS after HePa in CRC patients. In univariate analysis, perioperative RBC BloT (p=0.0205) and FFP BloT (p=0.0065) were positively associated with a poor OS. In multivariate analysis, the FFP BloT (p=0.0091) was an independent predictor for poor OS. The authors concluded, that the use of FFP BloT is associated with negative OS after elective HePa of CRC patients with liver metastasis.

The same authors (36) evaluated perioperative IOB and BloT in 82 PaCa patients and correlated the IOB/BloT results with OS in PaCa patients. The FFP BloT was an independent predictor of disease-free survival (DFS) in the Cox proportional regression (CPR) model and FFP BloTs (p=0.003) were positively associated with poor OS in the CPR model. The authors concluded, that the FFP BloT is associated with a poor therapeutic outcome after elective PaSurg for PaCa.

Iwase et al. (37) reported the results of post-operative lymphocyte count (LyC) on the outcome of radical resection in 34 patients with gallbladder carcinoma (GBC). They found, that intraoperative BloT was negatively correlated with DFS in univariate analysis (p=0.029) and the LyCs of less than 1,000 counts/μl correlated significantly with high levels of IOBs, and the need of BloTs. The study suggested that LyC measurement could help in the prediction of risk for IOB and BloT and decision making in the postoperative management of patients with GBC.

Yamamoto et al. (38) assessed the perioperative BloTs in a cohort of 168 patients with HCC who underwent HePa. They constructed a preoperative scoring system (SCORE) for BloTs with four variables: platelet count <10×104/mm3 (2 points), α-fetoprotein ≥80 ng/ml (1 point), tumor size ≥4.0 cm (1 point), and major hepatectomy (1 point). The SCORE showed an area under the curve (AUC) of 0.76. Their SCORE was highly predictive for BloTs and in HePa patients the SCORE clearly improved the incidence of perioperative BloTs in the following order; SCORE 3 or more, SCORE 2, SCORE 1, and SCORE 0 (45%; 38%; 10% and 3%, respectively). The study showed that SCORE would be useful for assessing the need for intraoperative BloTs during HePa for HCC.

Kaneko et al. (39) assessed the impact of perioperative allogeneic BloTs on survival in 108 elderly patients (≥75 years) with CRC. Tumor depth, lymph node metastasis, and Hb levels were significantly associated with perioperative BloTs. The CRC patients with BloTs had significantly worse OS compared to CRC patients who did not receive BloTs. In the multivariate analysis, perioperative BloT (hazard ratio=3.16, 95% confidence interval=1.11-8.98, p=0.031) was the only independent predictor of OS. The authors concluded that perioperative BloT was significantly associated with increased mortality in elderly patients with CRC.

Tamagawa et al. (40) evaluated the long-term outcome of 122 patients with Borrmann type IV gastric cancer undergoing curative resection at Yokohama University Hospital and Kanagawa Cancer Center, Japan. They found that IOB was an independent prognostic factor of OS (IOB <400 versus ≥400 ml, risk ratio 1.64; p=0.045). The authors concluded that the control of IOB has a positive impact on the OS of patients with curative resection for Borrmann type IV gastric cancer.

Collins et al. (41) investigated perioperative variables associated with prolonged intensive care unit (ICU) stay following cytoreductive surgery for 56 ovarian cancer patients categorized according to length of ICU stay (<48 h, 37 patients versus ≥48 h, 19 patients). The duration of operation, IOBs, and BloTs associated significantly with a prolonged ICU stay, when the perioperative variables were compared across the two study groups. They concluded that the identification of possible perioperative risk factors and the management of IOB will improve surgical planning and help conserve ICU resources.

Watanabe et al. (42) studied the impact of IOB on DFS and OS in 198 patients with locally advanced esophageal cancer (EC), who underwent preoperative adjuvant chemotherapy and curative resection as standard treatment. Both DFS and OS were significantly worse in the high IOB EC patients than in the low IOB EC patients. Furthermore, multivariate analysis identified high IOB as an independent factor for predicting poor RFS and OS. They concluded that controlling IOB is important for patients with locally advanced EC.

However, there is lack of reports on the effects of IOB complications and BloTs on the outcome of elderly Ccy patients. Ccy is a more complex procedure in elderly Chole patients, and consequently they may have enhanced risk for IOB and BloT. This risk has not been reported earlier and therefore this investigation is performed to assess whether elderly Ccy patients have a higher risk for IOBs and BloTs than younger Ccy patients. The elderly Ccy patients are more likely to have chemical thromboprophylaxis than their younger counterparts, which may increase the risk for IOB following Ccy (15). The present study shows that elderly Ccy patients have IOBs more often and both OC procedure and emergency surgery increase this risk even further. Over 20% of the elderly Ccy patients undergoing emergency LC needed BloTs. This percentage increased to over 25% when the procedure was converted from LC to OC. The suspected complexity of emergency Ccy in elderly Chole patients (23) may have influenced the surgeon’s decision to prefer OC over LC in these patients.

Only a minority of the patients in this study exhibited significant preoperative anemia, while guidelines recommend a quite restrictive approach, with hemoglobin levels between 70 to 80 g/l (7 to 8 g/dl) indicating the need for RBC transfusions (43, 44). The findings of the present study indicated that elderly Ccy patients received BloTs rather frequently; however, only one or two BloT units were usually administered. This may be linked to the challenges faced by elderly Chole patients in maintaining adequate hemodynamics during the Ccy.

Conclusion

A national registry of BloTs in surgery was established in Finland to investigate and demonstrate the utilization of blood components in different therapeutic procedures (24-30). However, there is lack of studies assessing the role of IOB complications leading to BloTs in elderly patients with Ccy, which is one of the most common surgical procedure performed in elderly patients. Therefore, the purpose of this work was to investigate the IOBs and BloTs in a cohort of 17,412 Ccys in Finland. This study showed that elderly Chole patients with Ccy have enhanced risk for IOB complications and BloTs than their younger counterparts. Furthermore, elderly Ccy patients had more often conversions to OC surgery than younger Ccy patients.

Acknowledgements

The study was funded by the North Savo Regional Fund (Pohjois-Savon Maakuntarahasto).

Footnotes

  • Authors’ Contributions

    All Authors contributed to the collection and analysis of data, drafting, and revising the manuscript, read and approved the final article.

  • Conflicts of Interest

    The Authors have no conflicts of interest or financial ties to disclose.

  • Received July 26, 2024.
  • Revision received August 8, 2024.
  • Accepted August 17, 2024.

This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY-NC-ND) 4.0 international license (https://creativecommons.org/licenses/by-nc-nd/4.0).

References

  1. ↵
    1. Stinton LM,
    2. Shaffer EA
    : Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver 6(2): 172-187, 2012. DOI: 10.5009/gnl.2012.6.2.172
    OpenUrlCrossRefPubMed
    1. Teixeira UF,
    2. Goldoni MB,
    3. Machry MC,
    4. Ceccon PN,
    5. Fontes PR,
    6. Waechter FL
    : Ambulatory laparoscopic cholecystectomy is safe and cost-effective: a Brazilian single center experience. Arq Gastroenterol 53(2): 103-107, 2016. DOI: 10.1590/S0004-28032016000200010
    OpenUrlCrossRefPubMed
  3. ↵
    1. Kamarajah SK,
    2. Karri S,
    3. Bundred JR,
    4. Evans RPT,
    5. Lin A,
    6. Kew T,
    7. Ekeozor C,
    8. Powell SL,
    9. Singh P,
    10. Griffiths EA
    : Perioperative outcomes after laparoscopic cholecystectomy in elderly patients: a systematic review and meta-analysis. Surg Endosc 34(11): 4727-4740, 2020. DOI: 10.1007/s00464-020-07805-z
    OpenUrlCrossRefPubMed
    1. Ukkonen M,
    2. Kivivuori A,
    3. Rantanen T,
    4. Paajanen H
    : Emergency abdominal operations in the elderly: a multivariate regression analysis of 430 consecutive patients with acute abdomen. World J Surg 39(12): 2854-2861, 2015. DOI: 10.1007/s00268-015-3207-1
    OpenUrlCrossRefPubMed
    1. Eskelinen M,
    2. Meklin J,
    3. Syrjänen K,
    4. Eskelinen M
    : Performance of a diagnostic score in confirming acute cholecystitis among patients with acute abdominal pain. Anticancer Res 40(12): 6947-6956, 2020. DOI: 10.21873/anticanres.14719
    OpenUrlAbstract/FREE Full Text
    1. Eskelinen M,
    2. Meklin J,
    3. Syrjänen K,
    4. Eskelinen M
    : A diagnostic score (DS) is a powerful tool in diagnosis of acute appendicitis in elderly patients with acute abdominal pain. Anticancer Res 41(3): 1459-1469, 2021. DOI: 10.21873/anticanres.14904
    OpenUrlAbstract/FREE Full Text
  7. ↵
    1. Eskelinen M,
    2. Meklin J,
    3. Selander T,
    4. Syrjänen K,
    5. Eskelinen M
    : History-taking, clinical signs, tests and scores for detection of non-organic dyspepsia (NOD) among patients with acute abdominal pain (AAP). Cancer Diagn Progn 1(4): 265-274, 2021. DOI: 10.21873/cdp.10034
    OpenUrlCrossRefPubMed
  8. ↵
    1. Harju J,
    2. Pääkkönen M,
    3. Eskelinen M
    : Comparison of the quality of life after minilaparotomy cholecystectomy versus laparoscopic cholecystectomy: a prospective randomized study. Isr Med Assoc J 9(3): 147-148, 2007.
    OpenUrlPubMed
    1. Aspinen S,
    2. Kärkkäinen J,
    3. Harju J,
    4. Juvonen P,
    5. Kokki H,
    6. Eskelinen M
    : Improvement in the quality of life following cholecystectomy: a randomized multicenter study of health status (RAND-36) in patients with laparoscopic cholecystectomy versus minilaparotomy cholecystectomy. Qual Life Res 26(3): 665-671, 2017. DOI: 10.1007/s11136-016-1485-1
    OpenUrlCrossRefPubMed
    1. Saimanen I,
    2. Kuosmanen V,
    3. Rahkola D,
    4. Selander T,
    5. Kärkkäinen J,
    6. Harju J,
    7. Aspinen S,
    8. Eskelinen M
    : RAND-36-item health survey: a comprehensive test for long-term outcome and health status following surgery. Anticancer Res 39(6): 2927-2933, 2019. DOI: 10.21873/anticanres.13422
    OpenUrlAbstract/FREE Full Text
    1. Saimanen I,
    2. Kuosmanen V,
    3. Harju J,
    4. Selander T,
    5. Aspinen S,
    6. Eskelinen M
    : A Finnish version of RAND-36-item health survey versus structured interview 8 years postoperatively. In Vivo 35(2): 907-911, 2021. DOI: 10.21873/invivo.12330
    OpenUrlAbstract/FREE Full Text
  12. ↵
    1. Eskelinen M,
    2. Repo A,
    3. Saimanen I,
    4. Selander T,
    5. Kärkkäinen J,
    6. Juvonen P,
    7. Aspinen S,
    8. Pulkkinen J,
    9. Eskelinen M
    : First RAND-36-item health survey in three-dimensional laparoscopy cholecystectomy: a prospective randomized study. In Vivo 37(3): 1192-1197, 2023. DOI: 10.21873/invivo.13195
    OpenUrlAbstract/FREE Full Text
  13. ↵
    1. Repo A,
    2. Eskelinen M,
    3. Saimanen I,
    4. Selander T,
    5. Kärkkäinen J,
    6. Juvonen P,
    7. Aspinen S,
    8. Pulkkinen J,
    9. Eskelinen M
    : Patient-reported outcome measure (PROM) Rand-36-item health survey for gallstone disease patients five years following surgery: a prospective randomized study. In Vivo 38(3): 1213-1219, 2024. DOI: 10.21873/invivo.13557
    OpenUrlAbstract/FREE Full Text
  14. ↵
    1. Eskelinen M,
    2. Saimanen I,
    3. Selander T,
    4. Kärkkäinen J,
    5. Juvonen P,
    6. Aspinen S,
    7. Eskelinen M
    : Three-dimensional laparoscopy (3D-LC) versus minilaparotomy (MC) in cholecystectomy: a prospective randomized study. In Vivo 36(6): 2835-2839, 2022. DOI: 10.21873/invivo.13022
    OpenUrlAbstract/FREE Full Text
  15. ↵
    1. Liu DS,
    2. Stevens S,
    3. Wong E,
    4. Fong J,
    5. Mori K,
    6. Ward S,
    7. Lee S,
    8. Howard T,
    9. Jain A,
    10. Gill AS,
    11. Beh PS,
    12. Slevin M,
    13. Jamel W,
    14. Fleming N,
    15. Bennet S,
    16. Chung C,
    17. Crowe A,
    18. Muralidharan V, VERITAS Collaborative
    : Pre-operative and intra-operative chemical thromboprophylaxis increases bleeding risk following elective cholecystectomy: a multicentre (PROTECTinG) study. ANZ J Surg 90(12): 2449-2455, 2020. DOI: 10.1111/ans.15998
    OpenUrlCrossRefPubMed
  16. ↵
    1. Carlomagno N,
    2. Tammaro V,
    3. Scotti A,
    4. Candida M,
    5. Calogero A,
    6. Santangelo ML
    : Is day-surgery laparoscopic cholecystectomy contraindicated in the elderly? Results from a retrospective study and literature review. Int J Surg 33: S103-S107, 2016. DOI: 10.1016/j.ijsu.2016.06.024
    OpenUrlCrossRefPubMed
    1. Ramírez-Giraldo C,
    2. Rosas-Morales C,
    3. Vásquez F,
    4. Isaza-Restrepo A,
    5. Ibáñez-Pinilla M,
    6. Vargas-Rubiano S,
    7. Vargas-Barato F
    : Laparoscopic cholecystectomy in super elderly (> 90 years of age): safety and outcomes. Surg Endosc 37(8): 5989-5998, 2023. DOI: 10.1007/s00464-023-10048-3
    OpenUrlCrossRefPubMed
    1. van Heesewijk AE,
    2. Lammerts RGM,
    3. Haveman JW,
    4. Meerdink M,
    5. van Leeuwen BL,
    6. Pol RA
    : Outcome after cholecystectomy in the elderly. Am J Surg 218(2): 368-373, 2019. DOI: 10.1016/j.amjsurg.2018.12.018
    OpenUrlCrossRefPubMed
    1. Pessaux P,
    2. Regenet N,
    3. Tuech JJ,
    4. Rouge C,
    5. Bergamaschi R,
    6. Arnaud JP
    : Laparoscopic versus open cholecystectomy. Surg Laparosc Endosc Percutan Tech 11(4): 252-255, 2001. DOI: 10.1097/00129689-200108000-00005
    OpenUrlCrossRefPubMed
    1. Sutcliffe RP,
    2. Hollyman M,
    3. Hodson J,
    4. Bonney G,
    5. Vohra RS,
    6. Griffiths EA, CholeS study group, West Midlands Research Collaborative
    : Preoperative risk factors for conversion from laparoscopic to open cholecystectomy: a validated risk score derived from a prospective U.K. database of 8820 patients. HPB (Oxford) 18(11): 922-928, 2016. DOI: 10.1016/j.hpb.2016.07.015
    OpenUrlCrossRefPubMed
    1. El Nakeeb A,
    2. Mahdy Y,
    3. Salem A,
    4. El Sorogy M,
    5. El Rafea AA,
    6. El Dosoky M,
    7. Said R,
    8. Ellatif MA,
    9. Alsayed MMA
    : Open cholecystectomy has a place in the laparoscopic era: a retrospective cohort study. Indian J Surg 79(5): 437-443, 2017. DOI: 10.1007/s12262-017-1622-2
    OpenUrlCrossRefPubMed
  22. ↵
    1. Hungness ES,
    2. Soper NJ
    : Management of common bile duct stones. J Gastrointest Surg 10(4): 612-619, 2006. DOI: 10.1016/j.gassur.2005.08.015
    OpenUrlCrossRefPubMed
  23. ↵
    1. Akasu T,
    2. Kinoshita A,
    3. Imai N,
    4. Hirose Y,
    5. Yamaguchi R,
    6. Yokota T,
    7. Iwaku A,
    8. Koike K,
    9. Saruta M
    : Clinical characteristics and short-term outcomes in patients with acute cholecystitis over aged >80 years. Geriatr Gerontol Int 19(3): 208-212, 2019. DOI: 10.1111/ggi.13588
    OpenUrlCrossRefPubMed
  24. ↵
    1. Lammi JP,
    2. Eskelinen M,
    3. Tuimala J,
    4. Saarnio J,
    5. Rantanen T
    : Blood transfusions in major pancreatic surgery: a 10-year cohort study including 1404 patients undergoing pancreatic resections in Finland. Scand J Surg 108(3): 210-215, 2019. DOI: 10.1177/1457496918812207
    OpenUrlCrossRefPubMed
  25. ↵
    1. Lammi JP,
    2. Eskelinen M,
    3. Tuimala J,
    4. Selander T,
    5. Saarnio J,
    6. Rantanen T
    : Perioperative changes in hemoglobin levels during major hepatopancreatic surgery in transfused and non-transfused patients. Scand J Surg 110(3): 407-413, 2021. DOI: 10.1177/145749690964362
    OpenUrlCrossRefPubMed
  26. ↵
    1. Palo R,
    2. Ali-Melkkilä T,
    3. Hanhela R,
    4. Jäntti V,
    5. Krusius T,
    6. Leppänen E,
    7. Mahlamäki EK,
    8. Perhoniemi V,
    9. Rajamäki A,
    10. Rautonen J,
    11. Salmenperä M,
    12. Salo H,
    13. Salonen I,
    14. Savolainen ER,
    15. Sjövall S,
    16. Suistomaa M,
    17. Syrjälä M,
    18. Tienhaara A,
    19. Vähämurto M,
    20. Mäki T
    : Development of permanent national register of blood component use utilizing electronic hospital information systems. Vox Sang 91(2): 140-147, 2006. DOI: 10.1111/j.1423-0410.2006.00814.x
    OpenUrlCrossRefPubMed
    1. Palo R,
    2. Capraro L,
    3. Hovilehto S,
    4. Koivuranta M,
    5. Krusius T,
    6. Loponen E,
    7. Mäntykoski R,
    8. Pentti J,
    9. Pitkänen O,
    10. Raitakari M,
    11. Rimpiläinen J,
    12. Salmenperä M,
    13. Salo H,
    14. Mäki T
    : Population-based audit of fresh-frozen plasma transfusion practices. Transfusion 46(11): 1921-1925, 2006. DOI: 10.1111/j.1537-2995.2006.00998.x
    OpenUrlCrossRefPubMed
    1. Palo R,
    2. Ahonen J,
    3. Salo H,
    4. Salmenperä M,
    5. Krusius T,
    6. Mäki T
    : Transfusion of red blood cells: no impact on length of hospital stay in moderately anaemic parturients. Acta Anaesth Scand 51(5): 565-569, 2007. DOI: 10.1111/j.1399-6576.2007.01265.x
    OpenUrlCrossRefPubMed
    1. Palo R,
    2. Capraro L,
    3. Hanhela R,
    4. Koivuranta M,
    5. Nikkinen L,
    6. Salmenperä M,
    7. Salonen I,
    8. Sjövall S,
    9. Tienhaara A,
    10. Vähämurto M,
    11. Mäki T
    : Platelet transfusions in adult patients with particular reference to patients undergoing surgery. Transfusion Med 20(1): 30-37, 2010. DOI: 10.1111/j.1365-3148.2009.00970.x
    OpenUrlCrossRefPubMed
  30. ↵
    1. Suuronen S,
    2. Kivivuori A,
    3. Tuimala J,
    4. Paajanen H
    : Bleeding complications in cholecystectomy: a register study of over 22,000 cholecystectomies in Finland. BMC Surg 15: 97, 2015. DOI: 10.1186/s12893-015-0085-2
    OpenUrlCrossRefPubMed
  31. ↵
    1. Acheson AG,
    2. Brookes MJ,
    3. Spahn DR
    : Effects of allogeneic red blood cell transfusions on clinical outcomes in patients undergoing colorectal cancer surgery. Ann Surg 256(2): 235-244, 2012. DOI: 10.1097/SLA.0b013e31825b35d5
    OpenUrlCrossRefPubMed
  32. ↵
    1. Odutayo A,
    2. Desborough MJ,
    3. Trivella M,
    4. Stanley AJ,
    5. Dorée C,
    6. Collins GS,
    7. Hopewell S,
    8. Brunskill SJ,
    9. Kahan BC,
    10. Logan RF,
    11. Barkun AN,
    12. Murphy MF,
    13. Jairath V
    : Restrictive versus liberal blood transfusion for gastrointestinal bleeding: a systematic review and meta-analysis of randomised controlled trials. Lancet Gastroenterol Hepatol 2(5): 354-360, 2017. DOI: 10.1016/S2468-1253(17)30054-7
    OpenUrlCrossRefPubMed
  33. ↵
    1. Papadoniou N,
    2. Kosmas C,
    3. Gennatas K,
    4. Polyzos A,
    5. Mouratidou D,
    6. Skopelitis E,
    7. Tzivras M,
    8. Sougioultzis S,
    9. Papastratis G,
    10. Karatzas G,
    11. Papalambros E,
    12. Tsavaris N
    : Prognostic factors in patients with locally advanced (unresectable) or metastatic pancreatic adenocarcinoma: a retrospective analysis. Anticancer Res 28(1B): 543-549, 2008.
    OpenUrlAbstract/FREE Full Text
  34. ↵
    1. Fujiwara Y,
    2. Shiba H,
    3. Furukawa K,
    4. Iida T,
    5. Haruki K,
    6. Gocho T,
    7. Wakiyama S,
    8. Hirohara S,
    9. Ishida Y,
    10. Misawa T,
    11. Ohashi T,
    12. Yanaga K
    : Glasgow prognostic score is related to blood transfusion requirements and post-operative complications in hepatic resection for hepatocellular carcinoma. Anticancer Res 30(12): 5129-5136, 2010.
    OpenUrlAbstract/FREE Full Text
  35. ↵
    1. Shiba H,
    2. Ishida Y,
    3. Haruki K,
    4. Furukawa K,
    5. Fujiwara Y,
    6. Iwase R,
    7. Ohkuma M,
    8. Ogawa M,
    9. Misawa T,
    10. Yanaga K
    : Negative impact of fresh-frozen plasma transfusion on prognosis after hepatic resection for liver metastases from colorectal cancer. Anticancer Res 33(6): 2723-2728, 2013.
    OpenUrlAbstract/FREE Full Text
  36. ↵
    1. Shiba H,
    2. Misawa T,
    3. Fujiwara Y,
    4. Futagawa Y,
    5. Furukawa K,
    6. Haruki K,
    7. Iida T,
    8. Iwase R,
    9. Yanaga K
    : Negative impact of fresh-frozen plasma transfusion on prognosis of pancreatic ductal adenocarcinoma after pancreatic resection. Anticancer Res 33(9): 4041-4047, 2013.
    OpenUrlAbstract/FREE Full Text
  37. ↵
    1. Iwase R,
    2. Shiba H,
    3. Haruki K,
    4. Fujiwara Y,
    5. Furukawa K,
    6. Futagawa Y,
    7. Wakiyama S,
    8. Misawa T,
    9. Yanaga K
    : Post-operative lymphocyte count may predict the outcome of radical resection for gallbladder carcinoma. Anticancer Res 33(8): 3439-3444, 2013.
    OpenUrlAbstract/FREE Full Text
  38. ↵
    1. Yamamoto Y,
    2. Ikoma H,
    3. Morimura R,
    4. Konishi H,
    5. Murayama Y,
    6. Komatsu S,
    7. Shiozaki A,
    8. Kuriu Y,
    9. Kubota T,
    10. Nakanishi M,
    11. Ichikawa D,
    12. Fujiwara H,
    13. Okamoto K,
    14. Sakakura C,
    15. Ochiai T,
    16. Otsuji E
    : Predictive scoring system assessing the need for intraoperative blood transfusions during hepatectomy for hepatocellular carcinoma. Anticancer Res 34(1): 313-318, 2014.
    OpenUrlAbstract/FREE Full Text
  39. ↵
    1. Kaneko M,
    2. Sasaki S,
    3. Ishimaru K,
    4. Terai E,
    5. Nakayama H,
    6. Watanabe T
    : The impact of perioperative allogeneic blood transfusion on survival in elderly patients with colorectal cancer. Anticancer Res 35(6): 3553-3558, 2015.
    OpenUrlAbstract/FREE Full Text
  40. ↵
    1. Tamagawa H,
    2. Aoyama T,
    3. Kano K,
    4. Numata M,
    5. Atsumi Y,
    6. Hara K,
    7. Kazama K,
    8. Koumori K,
    9. Murakawa M,
    10. Hashimoto I,
    11. Maezawa Y,
    12. Yamada T,
    13. Yukawa N,
    14. Yoshikawa T,
    15. Masuda M,
    16. Oshima T,
    17. Rino Y
    : The impact of intraoperative blood loss on the long-term prognosis after curative resection for Borrmann type IV gastric cancer: a retrospective multicenter study. Anticancer Res 40(1): 405-412, 2020. DOI: 10.21873/anticanres.13967
    OpenUrlAbstract/FREE Full Text
  41. ↵
    1. Collins A,
    2. Spooner S,
    3. Horne J,
    4. Chainrai M,
    5. Runau F,
    6. Bourne T,
    7. Moss EL,
    8. Davies Q,
    9. Chattopadhyay S,
    10. Bharathan R
    : Peri-operative variables associated with prolonged intensive care stay following cytoreductive surgery for ovarian cancer. Anticancer Res 41(6): 3059-3065, 2021. DOI: 10.21873/anticanres.15089
    OpenUrlAbstract/FREE Full Text
  42. ↵
    1. Watanabe H,
    2. Kano K,
    3. Hashimoto I,
    4. Tanabe M,
    5. Onuma S,
    6. Morita J,
    7. Nagasawa S,
    8. Kanematsu K,
    9. Aoyama T,
    10. Yamada T,
    11. Ogata T,
    12. Rino Y,
    13. Saito A,
    14. Oshima T
    : Intraoperative blood loss impacts recurrence and survival in patients with locally advanced esophageal cancer. Anticancer Res 43(11): 5173-5179, 2023. DOI: 10.21873/anticanres.16718
    OpenUrlAbstract/FREE Full Text
  43. ↵
    1. Carson JL,
    2. Grossman BJ,
    3. Kleinman S,
    4. Tinmouth AT,
    5. Marques MB,
    6. Fung MK,
    7. Holcomb JB,
    8. Illoh O,
    9. Kaplan LJ,
    10. Katz LM,
    11. Rao SV,
    12. Roback JD,
    13. Shander A,
    14. Tobian AA,
    15. Weinstein R,
    16. Swinton McLaughlin LG,
    17. Djulbegovic B, Clinical Transfusion Medicine Committee of the AABB
    : Red blood cell transfusion: a clinical practice guideline from the AABB*. Ann Intern Med 157(1): 49, 2012. DOI: 10.7326/0003-4819-157-1-201206190-00429
    OpenUrlCrossRefPubMed
  44. ↵
    1. Carson JL,
    2. Guyatt G,
    3. Heddle NM,
    4. Grossman BJ,
    5. Cohn CS,
    6. Fung MK,
    7. Gernsheimer T,
    8. Holcomb JB,
    9. Kaplan LJ,
    10. Katz LM,
    11. Peterson N,
    12. Ramsey G,
    13. Rao SV,
    14. Roback JD,
    15. Shander A,
    16. Tobian AA
    : Clinical Practice Guidelines From the AABB: Red blood cell transfusion thresholds and storage. JAMA 316(19): 2025, 2016. DOI: 10.1001/jama.2016.9185
    OpenUrlCrossRefPubMed
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Intraoperative Bleeding Complications Leading to Blood Transfusions (BloTs) in 17,412 Cholecystectomies in Finland: A Study With Special Reference to Elderly Patients
ANTTI KIVIVUORI, PEKKA LAMMI, MATTI ESKELINEN, TUOMO RANTANEN, HANNU PAAJANEN, JUKKA PULKKINEN, MIKA UKKONEN
Anticancer Research Oct 2024, 44 (10) 4449-4456; DOI: 10.21873/anticanres.17274
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